9 Months in Pincher – Blew Me Away

2012
Withrana, Dinesh

I spent 9 months of my clerkship in Pincher Creek, Alberta, completing mandatory rotations in family medicine, emergency medicine, obstetrics and gynecology, psychiatry, and anesthesia. In that time I also experienced internal medicine, surgery, and pediatrics, although I spent the final 3 months of my clerkship completing these 3 rotations. Here is an explanation for my reasons of choosing a clerkship based in family medicine and a recollection of my experiences in Pincher.

In an attempt to transition medical students from textbooks to clinical practice, the position of the clinical clerk has been instituted. The idea being that clerks would be able to experience clinical medicine under the guidance of practicing physicians. The term clerk has been applied to young lawyers who assist judges and senior attorneys in research and drafting of documents, benefiting from education from their supervisors, so this may be from where the medical profession adopted the term clerk. However, Webster’s defines a clerk as one employed to keep records or accounts or to perform general office work. The truth of the matter of is, today’s clinical clerks fulfill both definitions, and the distinction between the two roles is usually dependent upon the given preceptor on a rotation.

As urbanization progresses and medical school classes grow in number, urban medical centers grow in both patients and learners. To meet the demand of both, often learners are given jobs that do not necessary advance their education, but are important tasks for patient care nonetheless. An excellent example of this is rounding on 35 surgical patients, with the clinical clerk writing down vitals, lab values, exam findings, and plans that unfortunately no one has taken the time to discuss with the clerk. As a result, the clerk feels like he is doing “scut work”. Even I have been in this position, frustrated with menial tasks and feeling uninvolved in clinical decisions, but I hadn’t truly experienced it until I got back from Pincher Creek and started the urban clerkship.

The reason I chose a rural clerkship experience was primarily based on the above reasons. I wanted to be the clerk that was heavily involved in patient care and under direct supervision of practicing physicians who had an inherent desire to teach. For me, the urban clerkship was a place where I could have easily gotten lost in the crowd, losing out on learning opportunities to other learners who knew how to fight for them. The rural clerkship offered me a learning environment where I could feel settled in a “rotation” for 9 months, without new orientations on a biweekly basis, and without being a stranger on a new service every 2 months.

The RICC is not for everyone, however. If you don’t have a car and can’t get one, then you can’t travel back for academic days or just leisure trips back to the city. If you can’t be outside of a city for longer than a few weeks, then you may not be best suited for living in a rural town. That would include having family or spouses who depended on you being in the city, or vice versa. That brings me to my final reason for choosing the RICC: my wife Wing, who lives in Lethbridge and was only an hour away from Pincher.

There has been debate as to whether students gunning for a super competitive specialty (i.e. optho, plastics) would meet the urban contacts needed to secure a residency spot. Not that it can’t be done, as there have been RICC students who have matched to urology, pediatrics, obstetrics, etc in the past. The truth is that if you were interested in a specialty, you could easily arrange one-on-one time with a nearby specialist in Lethbridge or another nearby urban center on a weekly basis for 9 months. Imagine how good that reference letter would be compared to your colleagues who only spent a 2 week elective with their preceptor. And if you were interested in a surgical specialty, just imagine how your interview would go when you told them you have done several vasectomies by yourself or been 1st assist on over 20 c-sections.

There were a lot of highlights to my time in Pincher Creek. There were all the deliveries I got to do (including delivering my preceptor’s son). The casts I put on, the lacerations I sutured, the joint injections I did, the “AKs” I sprayed, and the spinals I put in. I still remember the look of this resident’s face after I put in a successful spinal anesthetic. My preceptor told me that he saw a bit of drool going down his face just as that CSF came out! All the procedures that were to be done were mine, and there were no other learners to compete for them, as the other RICC student was busy with the other doctors.

But I think the greatest strength of my experience in Pincher was the day to day goings on in the clinic. I was at home there and welcomed as a part of the family. I would laugh on a daily basis with the medical office assistants, and be teased by the nurses every lunch. I looked forward to going to work, partly because of all the cool stuff I got to do, but mostly because I loved the people I worked with, and they enjoyed working with me as well. Whenever I was on call with my preceptor, he would take me home and I would play board games with his kids and eat dinner with his family until we got the call to come back in. And even the patients got to know me well, as I would assign myself patient issues to research and address at their next visit. I will always remember the patient who I diagnosed with nephrotic syndrome when all he was coming in for was a prescription refill, and then got the appropriate work up done so he could get his kidney biopsy right away. I loved my RICC experience, and although it was tough being away from my medical school buddies, I would do it again in a second.

The major lesson I learned in clerkship was from my roommate Yang. And that lesson is: don’t be afraid to be a nuisance. Slow people down. Ask them lots of questions. Even if you think they are stupid. You will get way better answers and education out of your clerkship that way. Chances are, you will ask a few good ones too, and your preceptors will appreciate that you are keen to learn and that is what makes a good clerk/evaluation. Not the clerk who nods his head and tries to stay out of the way, because he/she is easily forgotten.

I’ll never regret those 9 months in Pincher Creek, and all the experience I gained within the realms of family medicine. Now in residency, I feel like a well-rounded, confident and capable physician. It is a real testament to the all-inclusiveness of family medicine.